journal
https://read.qxmd.com/read/31188124/hail-not-frail-ma-s-wellness-reach-expands
#21
JOURNAL ARTICLE
Frank Diamond
There was a time when insurers were accused (often rightly) of using wellness to lure healthier beneficiaries into MA. Now, the issue is whether wellness can help health plans manage medical spending. "To the degree they do minimize medical spending, the beneficiaries will presumptively be better off healthwise," says Joseph Newhouse of Harvard.
April 2019: Managed Care
https://read.qxmd.com/read/31188123/to-be-continued-the-search-for-a-cure-for-hiv
#22
JOURNAL ARTICLE
Thomas Reinke
Effective treatment has helped curb the epidemic, but practical cures have been elusive. Now being tested: a "sterilizing cure" that eradicates HIV from the body, and a "functional cure" that effectively reduces the viral load so it cannot be transmitted or progress to AIDS.
April 2019: Managed Care
https://read.qxmd.com/read/31188122/once-a-day-hiv-treatment-pricey-but-perhaps-worth-it
#23
JOURNAL ARTICLE
Ed Silverman
The annual pharmacy costs for single tablet regimens were $6,100 less compared with regimens involving multiple pills, at least among HIV patients who were taking the medicines as intended, according to an Express Scripts analysis. On average, the company found that health plans could save about $4,160 per patient per year.
April 2019: Managed Care
https://read.qxmd.com/read/31188121/in-trump-hiv-aids-groups-find-an-ally-who-s-tough-to-love
#24
JOURNAL ARTICLE
Richard Mark Kirkner
Adjusting their vision so it looks past the messenger and focuses on President Trump's stated goal to end AIDS by 2030 isn't easy for HIV/AIDS advocates. But they aren't being entirely dismissive, either. They have some faith in, and working relationships with, federal government health officials who will oversee implementation of the plan.
April 2019: Managed Care
https://read.qxmd.com/read/31188120/air-ambulance-turbulence-consolidation-cost-shifting-and-surprise-billing
#25
JOURNAL ARTICLE
Jan Greene
It is a heroic part of the American health system. Lives are saved, the dire consequences avoided. But the air ambulance industry is consolidating, prices are soaring, and insurers and providers continually fight over network issues. One consequence: Surprise billing that leaves patients owing tens of thousands of dollars.
April 2019: Managed Care
https://read.qxmd.com/read/31188119/emergency-medicine-the-origin-story
#26
JOURNAL ARTICLE
Robert Calandra
Doctors returning home from World War II knew that critically ill or injured patients had a better chance of survival if they were treated in a hospital. In 1976, emergency medicine became the country's 23rd recognized medical specialty. A lot happened between points A and B.
April 2019: Managed Care
https://read.qxmd.com/read/31188118/emergency-care-examined
#27
JOURNAL ARTICLE
Peter Wehrwein
It is a high-tech wonder and the product of generations of heavy investment in trauma care. But the emergency department is also the backdoor of the American health care system-a kind of open wound that is symptomatic of deficiencies of how American health care is organized, delivered, and paid for.
April 2019: Managed Care
https://read.qxmd.com/read/31188117/are-we-getting-what-we-pay-for
#28
JOURNAL ARTICLE
Michael D Dalzell
For all the talk about rapid increases in health care costs, we just might be getting better value for it. So say David Wamble, director of health economics at RTI Health Solutions, and colleagues in a recent Health Affairs article.
April 2019: Managed Care
https://read.qxmd.com/read/31188116/digitized-health-opens-rwe-floodgates-can-artificial-intelligence-harness-the-power
#29
JOURNAL ARTICLE
Thomas Reinke
Artificial intelligence is creating another new frontier in real-world evidence gathering and analysis. AI's algorithms can approximate-and maybe even surpass-human cognition and judgment in the analysis of complex medical data. Sure, humans will sign off, but AI software will do the heavy lifting.
April 2019: Managed Care
https://read.qxmd.com/read/31188115/association-health-plans-offer-lower-premiums-but-at-what-cost
#30
JOURNAL ARTICLE
Joseph Burns
AHPs are not required to cover all of the essential health benefits that ACA-compliant plans do, and they can base premiums on their expected or actual spending for health care rather than setting premiums at the community rate. But critics say you get what you pay for.
April 2019: Managed Care
https://read.qxmd.com/read/31188114/under-azar-and-boehler-cmmi-gets-its-groove-back
#31
JOURNAL ARTICLE
Richard Mark Kirkner
It seems that under HHS Secretary Alex Azar, the Center for Medicare and Medicaid Innovation-that ACA-enabled office given almost carte-blanche authority to experiment with new payment and care models-may be getting its groove back. Adam Boehler, hired last April as CMMI director, has cranked up output with a flurry of new models.
April 2019: Managed Care
https://read.qxmd.com/read/30883312/genetic-testing-gone-wild
#32
JOURNAL ARTICLE
Russel Kaufman
Genetic testing, when used prudently, can help physicians and patients make an informed treatment choice together. But when the DNA tests are marketed directly to consumers, they can place an undue burden on our already overloaded medical system.
March 2019: Managed Care
https://read.qxmd.com/read/30883311/what-we-talk-about-when-we-talk-about-value-based-care
#33
JOURNAL ARTICLE
Erik Johnson
In any instance when unanimity embraces an idea, a thoughtful person might ask whether there's true agreement or perhaps just a cone of vagueness that accommodates a variety of opinions and lets eyes of the beholders see what they want to see. With value-based care, it may be the latter.
March 2019: Managed Care
https://read.qxmd.com/read/30883310/prognosis-misdiagnosis-the-high-price-of-getting-it-wrong
#34
JOURNAL ARTICLE
Lola Butcher
By some counts misdiagnosis leads to up to 80,000 hospital deaths each year-and results in billions in wasted medical spending. Lack of feedback and miscommunication are among the causes. Researchers, advocates, and others are pushing for changes and "diagnostic excellence."
March 2019: Managed Care
https://read.qxmd.com/read/30883309/more-sunshine-say-some-pbm-forecasts-more-of-the-dark-arts-say-others
#35
JOURNAL ARTICLE
Robert Calandra
Recent mergers didn't quiet the growing frustration and concern employers, pharmacists, consumer advocates, state legislators, and some members of Congress have with the PBMs' lack of transparency. There are still so many questions, and getting answers anytime soon will be a chore.
March 2019: Managed Care
https://read.qxmd.com/read/30883308/the-growing-appeal-of-on-the-job-health-care
#36
JOURNAL ARTICLE
Jan Greene
The clinics range in size from a nurse who shows up in a mobile unit a few hours per week to a large-scale, full-service health clinic with multiple primary care providers and clinicians who can provide dental and vision care.
March 2019: Managed Care
https://read.qxmd.com/read/30883307/tis-most-excellent-union-mount-sinai-find-happiness-in-center-of-excellence
#37
JOURNAL ARTICLE
Joseph Burns
The Service Employees International Union Local 32BJ three years ago named Mount Sinai Health System as a preferred provider for participants and started a direct contract for those needing hip and knee replacement surgeries. In health care there are not many examples where each party succeeds. This is one of them.
March 2019: Managed Care
https://read.qxmd.com/read/30883306/staying-mad-walmart-gets-even-by-contracting-directly
#38
JOURNAL ARTICLE
Lola Butcher
In 1991, the world's second richest man griped about health care costs. Today, Sam Walton's Walmart empire is striking back with direct contracting. The retail giant is using centers-of-excellence contracts by which it pays high-value provider organizations to treat specific medical problems.
March 2019: Managed Care
https://read.qxmd.com/read/30883305/direct-contracting-walmart-came-a-calling-emory-answered
#39
JOURNAL ARTICLE
Lola Butcher
Unlike most payer-provider relationships, the parties took a go-slow approach. The plan was offered only to employees who worked in a subset of Walmart and Sam's Club outlets and lived or worked near Emory providers, and Walmart did not set premium levels to incentivize workers to choose the Emory ACO.
March 2019: Managed Care
https://read.qxmd.com/read/30883304/fda-gottlieb-get-real-about-real-world-evidence
#40
JOURNAL ARTICLE
Richard Mark Kirkner
Here we are in early 2019, and how quickly and firmly the FDA and the pharmaceutical industry will embrace RWE and its raw material, real-world data (RWD), remains an open question. If that embrace is ever to get beyond gestures and lip service, the FDA will need to change its rules and culture.
March 2019: Managed Care
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